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Keeping an Automated Eye on Sepsis


By Zack Martin, Managing Editor January 1, 2008

Sepsis is a killer, which is not news to inpatient facilities that struggle on a daily basis to keep their patients out of its devastating way.

Sepsis, often referred to as blood poisoning, occurs when the body overreacts to an infection.

Typically, the body's immune system will fight it off, but severe sepsis can lead to widespread inflammation and blood clotting, and eventually to organ failure and death. Critically ill patients, as well as those with chronic diseases and compromised immune systems, are at particularly high risk of developing the condition.

It's estimated that sepsis strikes 750,000 patients each year in the United States and that number could rise to 1 million by 2010, according to the Surviving Sepsis Web site (www.survivingsepsis.org), a partnership of the Society of Critical Care Medicine, the European Society of Intensive Care Medicine, and the International Sepsis Forum. Mortality rates for patients suffering from severe sepsis are 30% to 50%, and it's estimated that U.S. hospitals spend $17 billion a year treating the condition.

Change Of Focus

St. Vincent's Hospital for years had procedures in place to detect and treat sepsis, but combating the condition is difficult because clinicians have to stay focused on treating patients for the condition that brought them to the hospital, says Michelle Lecardo, R.N., critical care educator in the critical care department at the Bridgeport, Conn.-based hospital.

Detecting sepsis requires monitoring for a complex set of symptoms, and often a diagnosis comes too late. "By the time patients are exhibiting initial signs of sepsis they may already be experiencing organ failure," she says.

To get ahead of that curve, St. Vincent's Hospital last August deployed ProtocolWatch, a decision support system from Philips Medical Systems, Andover, Mass., that integrates with the hospital's monitoring hardware.

St. Vincent's already was using Philips' monitoring technology when Lecardo saw a ProtocolWatch demo at a Society of Critical Care Medicine conference. The hospital received a $10,000 grant from Philips to deploy the system. Lecardo declined to say how much the implementation cost beyond the initial grant.

Harmonization Of Hardware, Software

The software integrates with the monitoring hardware that is used to observe a patient's electrocardiogram, blood pressure, oxygen saturation and respiratory rate. The monitor can also be used to watch the patient's temperature if they have a Foley catheter, a latex tube inserted into the bladder to drain urine, in place. It also can gather additional cardiac information if the patient has a central line catheter.

St. Vincent's upgraded and replaced monitors to enable touch screens to be used by clinicians accessing the software. ProtocolWatch is available on 34 monitors, 26 in the intensive care unit and eight in the emergency department.

Whenever a patient is admitted to St. Vincent's intensive care unit, they are placed on one of the monitors. Patients admitted to the emergency department who are suffering from respiratory distress or other symptoms that raise a red flag also are hooked up to a ProtocolWatch-enabled monitor.

The monitors display pop-up windows that lead clinicians through a series of questions that help determine whether the patient is at risk of sepsis. Nurses enter information using the touch screen display.

Something as simple as a fever, combined with other data collected by ProtocolWatch, can trigger a request that the nurse check the patient's serum lactate level, a key indicator of whether the patient is developing sepsis.

If the lactate level is over a certain number, the nurse immediately will start the sepsis care schedule, or bundle, that can include a broad-spectrum antibiotics treatment or a variety of other treatments, depending on the test results.

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